Why are we pushing men into therapy?
The female-dominated industry is built on shaky evidence and fraught with devastating outcomes. What if we invested in wellness that actually works for men?
A recent Wall Street Journal article dug into a common refrain of the men’s and boy’s movement (of which I am a proud member!): men’s mental health is worse than women’s and as such, men should seek out more talk therapy and this requires the recruitment of more male therapists.
I take issue with Pamela Paul’s What Will Happen When All the Male Therapists Are Gone?, as like every other discussion on this topic I’ve read, she suffers from a giant blind spot:
Therapy is treated as an unquestioned social good, despite evidence that it is most often only modestly effective and frequently leaves clients worse off.
It is absolutely true that rates of male suicide are growing and outpace that of women. This is an alarming issue that requires attention.
Paul is of course correct in that psychotherapy is grossly dominated by women — both clinicians and researchers. Yet despite its status in the zeitgeist as a silver bullet for nearly any form of emotional discomfort, there is growing evidence that therapy often makes your sadness sadder, while the broader psychotherapy industry has been complicit in medical travesties including the overprescription of SSRIs and ADHD medications, as well as the medical gender transition of children — not to mention fueling a navel-gazing culture obsessed with diagnoses, fragility, and victimhood.
All of which begs the question: If female-created therapy is hurting us, why do we keep preaching that men get more therapy? The movement is treating men as defective women, prescribing them remedies designed for someone else. It is also looking backwards about what most of us assumed to be true and ignoring a growing popular and clinical dismay with the multi-billion dollar mental health care industry.
In this article I argue that we should calibrate broad mental / emotional care efforts to male proclivities: Less focus on expensive conversations with strangers and dangerous medications, more hanging out in person, community, exercise, being in nature, faith, dating, sex, marriage, starting families. These are all things on the decline and directly linked to the wellbeing of us all. They are all also mostly free.
In this article:
The misguided, blind faith that therapy is good
Therapy is not built for or by men — so why the obsession?
A healthy life IRL is better than talking about your feelings
Tentacles of therapy culture that especially hurt boys and young men
Real life therapy alternatives that are free or cheap and work
Watch Abigail Shrier on Mark Manson. Shrier’s book Bad Therapy does an excellent job unpacking how most of us have been wrong about therapy, especially as it pertains to kids.
The misguided, blind faith that therapy is good
Culturally, we assume therapy is always good. Whatever uncomfortable feeling is happening in your life, the answer is always therapy.
Work stress? Call a counselor.
Relationship struggles? Couples therapy ASAP.
Divorce? Therapy for the whole family.
Kid acting up? Send them to this great child psychologist I know.
Lonely? Go to therapy.
General malaise? You need a professional.
Today, the answer to any discomfort of the psyche is an expensive chat with a stranger.
Except there is not a whole lot of solid evidence that talk therapy does a whole lot for anyone except the therapist who likely has a heap of student debt and all the financial incentive to encourage you to visit their couch indefinitely.
Studies find that a minority of therapy clients do benefit from high-quality therapy, but the industry is barely regulated and there is no meaningful way for the average person to know whether your counselor adheres to best practices or is a licensed charlatan. The American Psychological Association’s website says in several spots that 20 sessions are needed for about half of clients to say they feel better, but there is no citation for that assertion. Also, saying you feel better is not the same as being better.
From the must-read New York Times article “Does Therapy Really Work? Let’s Unpack That:”
“Studies comprising some 650,000 patients suffering from a broad range of mental illnesses. ‘After more than half a century of research’ and ‘millions of invested funds,’ they wrote, the impact that therapy (and medication, for that matter) had on patients’ symptoms was ‘limited.’”
More urgently, a recent surge of reporting blames the talk therapy industry with travesties including over-prescription of SSRIs, ADHD meds, youth transgender medicalization and family estrangement — not to mention the overdiagnosis and medicalization of pretty much every mood, mental health, neurological and social disorder, including Autism, anxiety and depression.
Case in point: Recently a friend urged me to take the lead in planning a conference since I “don’t suffer from social anxiety.” In other words, apparently I thwart the mental health-inflicted majority because I am not shy. Is there a Big Pharma-enriching pill for my not-condition?
Articles criticizing mental health craze
If my assertions here are challenging, step back, take a 30,000-foot view. Ask yourself if this makes sense:
The number of people receiving mental health treatment is higher than ever (29% of women and 17% of men) — and so are mental illness diagnoses.
The math is not mathing.
I’m not the only one asking these questions. Consider:
The New York Times: Does Therapy Really Work? Let’s Unpack That
TIME: Therapy Isn’t Fixing America’s Mental Health Crisis
Author Brooks for The Atlantic: Being Anxious or Sad Does Not Make You Mentally Ill
The 74: America’s Most Popular Autism Therapy May Not Work — and May Seriously Harm Patients’ Mental Health
Newsweek: We’re Spending $300 Billion a Year on Mental Health Care. Why Is It Making Us Sicker?
Scott Galloway: The Cult of Therapy
Selda Koydemir on Substack: Why People Are Losing Trust in Psychotherapy
Therapy is not built for or by men — so why the obsession?
From James Nuzzo, an American gender researcher based in Australia:
In 2007, 57% of individuals employed in the psychology workforce in the U.S. were women compared to 43% men.
In 2023, 72% of individuals employed in the psychology workforce in the U.S. were women compared to 28% men.
Over the 17-year period between 2007 and 2023, women’s representation in the psychology workforce in the U.S. increased by 15% in raw representation terms, whereas men’s representation decreased by 15% in raw representation terms.
Perhaps the best illustration of the feminization of psychotherapy is Virginia Commonwealth University, where nearly all psychology grad students and faculty are women, and the campus mental health services for men focus narrowly on allyship and understanding transgenderism. Read about the whole, embarrassing situation here:
The disconnect between what men need and what the therapy industry provides is so vast, why is the men’s/boy’s movement hell-bent on shoehorning males a into broken industry?
A healthy life IRL is better than talking about your feelings
The men’s movement’s strategy seems to assume that if more men were therapists, therapy might be better.
But privately, many thoughtful men, including those I meet in the movement, have rolled their eyes and told me: “I am so sick of telling men to be vulnerable.”
It’s easier to guide a train already on the tracks than rerail one after a wreck. While I cannot find any meaningful effort to reform the psychology-industrial complex, there is new momentum that focuses on positive, healthy habits that tend to be preferred by men, but stand to benefit us all.
Let’s start with social connection of all kinds — friend, community, romantic, family — are time and again found by science, history and common sense to be the glue of humanity. These are falling apart and we unsuccessfully turn to professionals to fill the gaps.
Scott Galloway sums it up:
Sharing your troubles with your local bartender has fallen out of fashion. Talking to your friends remains an option, though friendship rates are declining, with 12% of people today saying they have no close friends at all. Alcohol consumption is at a 90-year low, with Gen Z driving the abstinence trend, robbing young people of one vital form of social lubrication.
I’ve been criticized for saying alcohol can be additive for many young people, but the risk to a 25-year-old liver is dwarfed by the risk of social isolation … We’re social animals. As social connections atrophy and fray, we’re becoming more anxious and depressed. Therapy is an expensive Band-Aid for a larger problem. But even taken on its own merits, only 9% of Americans give the U.S. healthcare system a grade of A or B for addressing mental illness, according to Gallup.
Instead, what does relieve the bulk of most mental health and mood struggles are activities that most Americans need more of — many of which are arguably more aligned with the way men deal with feelings and life:
Exercise. As a society, we’re too fat and sedentary. Good news! Working out is just as helpful to your mental health as therapy or drugs, according to a meta-analysis of 14,000 people. "We found that exercise was as effective as pharmacological treatments or psychological therapies as well," said the study’s researcher, University of Lancashire’s Andrew Clegg. Boys benefit from physical activity more than girls, and the social aspect of sports is good for us all, particularly men, it turns out. Let’s all take a cue from the guys on this one and get in our steps.
Hang out. Compared with girls and women who do more talking (and unhealthy ruminating) in their relationships, men benefit disproportionately from low-pressure companionship and shared activity — which translates into hanging out, joking, working out, gaming, watching sports, walking and fixing stuff. The social lives of people of all ages are painfully broken, including among young people who party and date less than any other generation. Who wants to join me following men’s lead on this and come over for a beer (or rosé or aperol spritz or whatever) after work?
Join or form a community. Being part of a neighborhood, friend, family, faith or work community of people with whom you share IRL experiences and memories and bear witness to each other’s’ lives is the stuff that has perpetuated the species — and is bewilderingly in short supply today. We can’t in good faith address a loneliness epidemic with prothletising 1:1 paid conversations.
Being in nature. There is growing evidence about the common-sense understanding that being in nature is good for your soul. Get some sun, revel in a pretty view, gaze at the trees, put your hands in the earth — better yet do so while exercizing along with other people.
Dating and sex. Let’s stop demonizing “incels” and start promoting the beautiful fact that humans are designed to socialize and flirt and kiss and copulate and everything falls apart when we ignore this — or individuals fail to believe they are worthy of romantic love. The science finds that men and women have similar sex drives, though the assumption has long held that men are hornier, so maybe this is a gendered solution?
Marriage and children. Marriage seems to suit men more than women, with gay men having the lowest divorce rates and lesbians the highest — and straight women filing the majority of their divorces. Most young men do want to date and marry, which has been mostly consistent over recent years, while fewer young women today feel the same — despite evidence that married mothers are the happiest of all women and single and childless women are most likely of all demographics (men, women, married, single, parents and non-parents) to take anti-depressants.
Read: Zombie theory: Women file for divorce because men are horrible
Again, gut check:
Which sounds like a better option for a young (or old) man insecure about his work and dating prospects, future and role in society?
Joining a months-long waitlist to spend $200 per hour in the office of a therapist (of either gender) to unpack his trauma and learn about setting boundaries …
… or joining a hiking club where he will be outdoors, exercising, getting fit, making friends, forming a community, possibly meeting a nice girlfriend with whom one afternoon he might sneak off and have fun sex in the woods which could lead to marriage and babies and more community and all the good things that you and I and all of humanity know in our bones has sustained individuals and society for millenia?
Tentacles of therapy culture that especially hurt boys and young men
Like most school districts in the United States, mine is under a nasty funding restraints with difficult cuts being negotiated. An early budget draft slashed mental health services which were swiftly reinstated after outcrys. What if those funds were redirected to more sports programs, extended recess or recruiting more male teachers — programs proven to be good for all students, especially our boys?
In general, the therapy-landen K12 experience is fraught with questionable mental health trends, especially in affluent communities and their competitive high schools — often fueling questionable diagnoses designed to boost GPAs and resumes. Consider that as much as 40% of the country’s most prestigious universities’ students enjoy extended exam time and flexible deadlines thanks to claims of learning disabilities. This, too is gendered as more women than men have been accepted to and graduate from universities for more than 40 years.
Also on the higher-ed front: ballooning college costs are increasingly driven by counseling services — services disproportionately used by women. According to Forbes’s Student Support Is Now On Par With Academic Prestige And Tuition Costs:
In 2023, Inside Higher Ed highlighted a survey of 3,000 college students and asked which wellness service or initiative mattered the most when making the decision to enroll at their college or university. According to the report, mental health support was the top wellness factor in choosing an institution.
Indeed 29% of respondents said mental health services mattered most, compared with 15% who named fitness and 7% physical health. Every day is backwards day at college!
Check out this 30-minute Old Dominion University recruitment video which leads with two photogenic students sharing about how the school supported them during a mental health crisis and a traumatic brain injury (respectively) with counseling services. If we’re worried about the gender college enrollment gap, let’s scale back our campus counseling spending and refocusing on ways to nurture healthy humans secure in their ability to solve their own problems and be of service to the world. These solutions are likely low-cost, saving all students in fees.
Real-life therapy alternatives that are free or cheap and work
Thankfully, there is a growing movement to address many of my suggestions here:
Guys all around the country are hanging out. Special shout-out to my Virginia friends Alex Vans whose app Choros curates IRL hangouts for men to facilitate old-fashioned friendships, and Mohan Sivaloganathan, co-founder of Dads for All which sponsors chapters of fathers who get together, hang and tackle service projects. Dads for All joins similar programs like Dad Guild in Vermont. These are all gaining momentum in short periods of time.
Let’s start early with building what se know is good for kids, especially boys: Get everyone off the treadmill of sedentary classroom life and structured extracurriculars, and back to independent play with more running and goofing around and figuring out relationships and friendships without adult micro-engineering. My favorite is Play Club from the organization LetGo, co-founded by free-range parenting godmother Lenore Skenazy.
Play Club offers a simple blueprint to create before- or after-school programs that consist of pretty much nothing. Kids run around and play in the school yard. No phones allowed. A teacher is present to keep everyone alive, but prohibited from organizing activities or interfering with squabbles that do not result in physical injury. Parents get safe, free care, kids have a healthy afternoon with other kids.
A parent testimonial:
“My own son, he’s a third grader, and he has anxiety and possibly ADHD, and I noticed on Play Club days he was way more calm after school, and his teacher would say he seemed less anxious or upset. He wasn’t having the big emotional reactions he would have at recess. There was definitely a difference in days he had Play Club and days he didn’t.”
Next week: Why are we advocating for more young men to join the broken, increasingly irrelevant college system?
Yes, yes, yes!!!
This is such a timely and thought-provoking piece that challenges a deeply embedded assumption in our culture: that therapy is always the default solution. I particularly appreciate the courage to question outcomes, not just intentions, and to ask whether current approaches are genuinely serving men...
The emphasis on community, physical activity, purpose, and real-world connection feels especially important. These aren't “alternatives” in a lesser sense; they are foundational to human wellbeing, and often align more closely with how many men process life and build resilience. Here I also credit Tom Golden and John Barry and so many other people of goodwill, who we stand upon the shoulders of to see reality more clearly.
At the same time, I think there’s an opportunity to continue refining this conversation by distinguishing between where therapy can help, and where broader social and cultural interventions may be far more effective. It’s not about rejecting support, but about designing it to be much better (and very different)...
Overall, this article is a valuable contribution that pushes us toward a more balanced, evidence-based, and human-centred approach to men’s wellbeing. One that meets men where they are, rather than trying to reshape them to fit a system.
Thank you Emma, for offering the beacon of hope and a vision to move forwards constructively.
I think men are much more hip and tuned in than they get credit for when it comes to, well, the “side effects” of therapy, particularly long-term therapy.
One, therapy can encourage excessive self-centeredness, if not outright narcissism. Therapy encourages patients to focus intently on their own hangups and ruminate about their past and present life. Therapy also tends to externalize blame: It’s all about your dysfunctional family, abusive ex, narcissistic boss, etc. While some introspection is essential for self-awareness, there’s a huge difference between self-examination and wallowing.
Next, therapy can lead to a codependency between the patient and the therapist. Therapists consciously or unconsciously encourage or condone this behavior because after all, therapists make more money the more you come to therapy. I’ve heard of patients going into meltdowns when their therapists went on vacation or on evenings, weekends, and holidays.
What’s more, therapy can keep you from taking action that can actually improve your life. One way therapy does this is by focusing so much on your past traumas and present predicaments that you fail to see future possibilities. Another way they do so is by failing to provide actionable advice: Few therapists will tell patients, “I think you really should consider Option X” or “I don’t think Option Y makes sense for you to take, but Option Z could work.” Many people could benefit from judiciously dispensed advice.